January is the peak of flu season in Georgia, and this year, hospitals, doctors' offices and local health departments have been inundated with people sick with the flu or those clamoring for a flu shot.

But according to federal data, only about 63 percent of U.S. health care workers got flu shots by November 2012. That number is higher than in recent years, but it's well below the 90 percent of vaccination federal officials say is necessary for optimal patient safety.

Many health care groups say the best way to bump up those low vaccination rates is to make flu shots mandatory for health care workers. In November, the National Association of County and City Health Officials (NACCHO) issued a policy statement advocating for mandatory flu vaccinations for health care workers and local health departments. The organization said people at higher risk for flu and complications from the virus have frequent contact with health care workers, and vaccination is the most effective way to prevent flu from spreading in these situations.

"Local health departments, with their emphasis on prevention of disease, are obligated to use a safe and effective measure to protect their staff and its clients, many of whom access public health resources specifically to avoid getting diseases such as influenza. A mandatory influenza vaccination policy, as a condition of employment, is the measure most likely to ensure high immunization rates among public health staff," the agency said in the statement.

With this policy statement, NACCHO joins other prominent medical organizations, such as the American Medical Association and the American Nurses Association, in supporting health care employers who require employees to get the flu vaccine.

Hospitals and health systems across the U.S. have been implementing policies for mandatory flu vaccines throughout the last few years. According to estimates from federal agencies, only about 60 to 70 percent of health care workers in health systems without a mandatory vaccination policy get the flu shot each year. When employers do implement such policies, nearly 90 percent of workers are vaccinated.

Although the policies are effective, they are also controversial, particularly since hospitals across the U.S. are cracking down on staff members who don't get vaccinated. In January, the Indiana University Health Goshen Hospital fired eight employees who refused to get a flu shot. A nurse was fired from her job at a Springfield, Mo., hospital when she stopped wearing the surgical mask required for those health workers who chose not to be vaccinated. Workers who balk at forced flu shots say such policies violate their right to make personal health choices.

"This is my body. I have a right to refuse the flu vaccine," Ethel Hoover, one of the nurses fired from the Indiana hospital, told ABCNews.com. "For 21 years, I have religiously not taken the flu vaccine, and now you're telling me that I believe in it."

The Georgia Department of Public Health does not require employees to get the flu vaccine. But several hospitals and health systems around the state have implemented mandatory vaccination policies, such as Emory Healthcare, Grady Health System and the Shepherd Center in Atlanta, MCG Health in Augusta and Redmond Regional Medical Center in Rome.

In 2011, the Arkansas Department of Health made an annual flu vaccination an official policy for its 5,400 employees across the state, even those who don't work directly with patients. Dr. Nate Smith, deputy director of the Arkansas Department of Health, said some employees and even some state legislators were concerned when the department first proposed making flu shots mandatory. But in the end, he said patient safety was the most important factor.

"Basically we need to protect our clients," Smith said. "Many of our patients are at high risk of complications if they were to get influenza. It's not reasonable for them to come to local health unit for services and end up getting infected with something that."

Along with vaccinations for measles, mumps and rubella, employees are required to get a yearly flu shot or apply for an exemption for a medical condition or a non-medical reason, such as a religious belief. People who are approved for an exemption must wear a surgical mask throughout flu season, starting Dec. 1 until March 31. Employees who don't comply with the policy will be disciplined.

Two years after its implementation, the rate of vaccination among ADH employees is over 90 percent. Smith said most employees understood the reason for the policy and were happy to get their flu shots. About 60 employees across Arkansas applied for medical or non-medical exemptions. According to Smith, so far no employee has been disciplined or dismissed for failing to get vaccinated.

Smith said the policy was the best way to make sure ADH upheld its obligation to keep its patients safe from the flu.

-Story by Carrie Gann, DPH Communications